|
KIT JUGGERKNOT 2.9MM DISPOSIBLE 912057
|
Facility
|
IP
|
$4,156.00
|
|
| Hospital Charge Code |
4519986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,036.44 |
| Max. Negotiated Rate |
$3,823.52 |
| Rate for Payer: Aetna Commercial |
$3,740.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,574.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,202.68
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$3,823.52
|
| Rate for Payer: Health EOS Commercial |
$3,698.84
|
| Rate for Payer: HFN Commercial |
$3,823.52
|
| Rate for Payer: Multiplan Commercial |
$3,324.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,493.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,823.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,036.44
|
| Rate for Payer: Quartz Commercial |
$2,493.60
|
| Rate for Payer: WEA Trust Commercial |
$2,285.80
|
| Rate for Payer: WPS Commercial |
$3,078.35
|
|
|
KIT JUGGERKNOT 2.9MM DISPOSIBLE 912057
|
Facility
|
OP
|
$4,156.00
|
|
| Hospital Charge Code |
4519986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,163.68 |
| Max. Negotiated Rate |
$16,624.00 |
| Rate for Payer: Aetna Commercial |
$3,740.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,574.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,163.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,701.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,078.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,994.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,202.68
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cigna Commercial |
$3,823.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,325.70
|
| Rate for Payer: Health EOS Commercial |
$3,698.84
|
| Rate for Payer: HFN Commercial |
$3,823.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,117.00
|
| Rate for Payer: Multiplan Commercial |
$3,324.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,493.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,823.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,036.44
|
| Rate for Payer: Quartz Commercial |
$2,701.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,493.60
|
| Rate for Payer: The Alliance Commercial |
$16,624.00
|
| Rate for Payer: WEA Trust Commercial |
$2,285.80
|
| Rate for Payer: WPS Commercial |
$3,078.35
|
|
|
KIT JUJUNOSTOMY
|
Facility
|
IP
|
$1,274.00
|
|
| Hospital Charge Code |
2973679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.26 |
| Max. Negotiated Rate |
$1,172.08 |
| Rate for Payer: Aetna Commercial |
$1,146.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,095.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.22
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,172.08
|
| Rate for Payer: Health EOS Commercial |
$1,133.86
|
| Rate for Payer: HFN Commercial |
$1,172.08
|
| Rate for Payer: Multiplan Commercial |
$1,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$764.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.08
|
| Rate for Payer: Quartz Beloit One Network |
$624.26
|
| Rate for Payer: Quartz Commercial |
$764.40
|
| Rate for Payer: WEA Trust Commercial |
$700.70
|
| Rate for Payer: WPS Commercial |
$943.65
|
|
|
KIT JUJUNOSTOMY
|
Facility
|
OP
|
$1,274.00
|
|
| Hospital Charge Code |
2973679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$356.72 |
| Max. Negotiated Rate |
$5,096.00 |
| Rate for Payer: Aetna Commercial |
$1,146.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,095.64
|
| Rate for Payer: Aetna Managed Medicare |
$356.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$828.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$637.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$611.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.22
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,172.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$712.93
|
| Rate for Payer: Health EOS Commercial |
$1,133.86
|
| Rate for Payer: HFN Commercial |
$1,172.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$955.50
|
| Rate for Payer: Multiplan Commercial |
$1,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$764.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.08
|
| Rate for Payer: Quartz Beloit One Network |
$624.26
|
| Rate for Payer: Quartz Commercial |
$828.10
|
| Rate for Payer: Quartz Medicare Advantage |
$764.40
|
| Rate for Payer: The Alliance Commercial |
$5,096.00
|
| Rate for Payer: WEA Trust Commercial |
$700.70
|
| Rate for Payer: WPS Commercial |
$943.65
|
|
|
KIT LEAD INTERSTIM II SURESCAN MRI 4.32MM X 28CM (RECHARGE FREE) 978B128
|
Facility
|
IP
|
$24,223.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
5603547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,869.27 |
| Max. Negotiated Rate |
$22,285.16 |
| Rate for Payer: Aetna Commercial |
$21,800.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,831.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,838.19
|
| Rate for Payer: Cash Price |
$7,266.90
|
| Rate for Payer: Cigna Commercial |
$22,285.16
|
| Rate for Payer: Health EOS Commercial |
$21,558.47
|
| Rate for Payer: HFN Commercial |
$22,285.16
|
| Rate for Payer: Multiplan Commercial |
$19,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$14,533.80
|
| Rate for Payer: Preferred Network Access Commercial |
$22,285.16
|
| Rate for Payer: Quartz Beloit One Network |
$11,869.27
|
| Rate for Payer: Quartz Commercial |
$14,533.80
|
| Rate for Payer: WEA Trust Commercial |
$13,322.65
|
| Rate for Payer: WPS Commercial |
$17,941.98
|
|
|
KIT LEAD INTERSTIM II SURESCAN MRI 4.32MM X 28CM (RECHARGE FREE) 978B128
|
Facility
|
OP
|
$24,223.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
5603547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,782.44 |
| Max. Negotiated Rate |
$96,892.00 |
| Rate for Payer: Aetna Commercial |
$21,800.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,831.78
|
| Rate for Payer: Aetna Managed Medicare |
$6,782.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,744.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,111.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,627.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,838.19
|
| Rate for Payer: Cash Price |
$7,266.90
|
| Rate for Payer: Cigna Commercial |
$22,285.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,555.19
|
| Rate for Payer: Health EOS Commercial |
$21,558.47
|
| Rate for Payer: HFN Commercial |
$22,285.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,167.25
|
| Rate for Payer: Multiplan Commercial |
$19,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$14,533.80
|
| Rate for Payer: Preferred Network Access Commercial |
$22,285.16
|
| Rate for Payer: Quartz Beloit One Network |
$11,869.27
|
| Rate for Payer: Quartz Commercial |
$15,744.95
|
| Rate for Payer: Quartz Medicare Advantage |
$14,533.80
|
| Rate for Payer: The Alliance Commercial |
$96,892.00
|
| Rate for Payer: WEA Trust Commercial |
$13,322.65
|
| Rate for Payer: WPS Commercial |
$17,941.98
|
|
|
KIT LEAD INTRODUCER INTERSTIM 3550-18
|
Facility
|
OP
|
$3,411.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5349491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.08 |
| Max. Negotiated Rate |
$13,644.00 |
| Rate for Payer: Aetna Commercial |
$3,069.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,933.46
|
| Rate for Payer: Aetna Managed Medicare |
$955.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,217.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,705.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,637.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,807.83
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Cigna Commercial |
$3,138.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,908.80
|
| Rate for Payer: Health EOS Commercial |
$3,035.79
|
| Rate for Payer: HFN Commercial |
$3,138.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,558.25
|
| Rate for Payer: Multiplan Commercial |
$2,728.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,046.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,138.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,671.39
|
| Rate for Payer: Quartz Commercial |
$2,217.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,046.60
|
| Rate for Payer: The Alliance Commercial |
$13,644.00
|
| Rate for Payer: WEA Trust Commercial |
$1,876.05
|
| Rate for Payer: WPS Commercial |
$2,526.53
|
|
|
KIT LEAD INTRODUCER INTERSTIM 3550-18
|
Facility
|
IP
|
$3,411.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5349491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,671.39 |
| Max. Negotiated Rate |
$3,138.12 |
| Rate for Payer: Aetna Commercial |
$3,069.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,933.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,807.83
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Cigna Commercial |
$3,138.12
|
| Rate for Payer: Health EOS Commercial |
$3,035.79
|
| Rate for Payer: HFN Commercial |
$3,138.12
|
| Rate for Payer: Multiplan Commercial |
$2,728.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,046.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,138.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,671.39
|
| Rate for Payer: Quartz Commercial |
$2,046.60
|
| Rate for Payer: WEA Trust Commercial |
$1,876.05
|
| Rate for Payer: WPS Commercial |
$2,526.53
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.4MM X 445MM & STONE CATCHER M0068403530
|
Facility
|
OP
|
$6,102.00
|
|
| Hospital Charge Code |
5804330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,708.56 |
| Max. Negotiated Rate |
$24,408.00 |
| Rate for Payer: Aetna Commercial |
$5,491.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,247.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,708.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,966.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,051.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,928.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,234.06
|
| Rate for Payer: Cash Price |
$1,830.60
|
| Rate for Payer: Cigna Commercial |
$5,613.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,414.68
|
| Rate for Payer: Health EOS Commercial |
$5,430.78
|
| Rate for Payer: HFN Commercial |
$5,613.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,576.50
|
| Rate for Payer: Multiplan Commercial |
$4,881.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,661.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,613.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,989.98
|
| Rate for Payer: Quartz Commercial |
$3,966.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,661.20
|
| Rate for Payer: The Alliance Commercial |
$24,408.00
|
| Rate for Payer: WEA Trust Commercial |
$3,356.10
|
| Rate for Payer: WPS Commercial |
$4,519.75
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.4MM X 445MM & STONE CATCHER M0068403530
|
Facility
|
IP
|
$6,102.00
|
|
| Hospital Charge Code |
5804330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,989.98 |
| Max. Negotiated Rate |
$5,613.84 |
| Rate for Payer: Aetna Commercial |
$5,491.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,247.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,234.06
|
| Rate for Payer: Cash Price |
$1,830.60
|
| Rate for Payer: Cigna Commercial |
$5,613.84
|
| Rate for Payer: Health EOS Commercial |
$5,430.78
|
| Rate for Payer: HFN Commercial |
$5,613.84
|
| Rate for Payer: Multiplan Commercial |
$4,881.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,661.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,613.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,989.98
|
| Rate for Payer: Quartz Commercial |
$3,661.20
|
| Rate for Payer: WEA Trust Commercial |
$3,356.10
|
| Rate for Payer: WPS Commercial |
$4,519.75
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.9MM X 440MM & STONE CATCHER M0068403550/M0068402980/M0068402940
|
Facility
|
IP
|
$7,899.00
|
|
| Hospital Charge Code |
5459256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,870.51 |
| Max. Negotiated Rate |
$7,267.08 |
| Rate for Payer: Aetna Commercial |
$7,109.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,793.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,186.47
|
| Rate for Payer: Cash Price |
$2,369.70
|
| Rate for Payer: Cigna Commercial |
$7,267.08
|
| Rate for Payer: Health EOS Commercial |
$7,030.11
|
| Rate for Payer: HFN Commercial |
$7,267.08
|
| Rate for Payer: Multiplan Commercial |
$6,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,739.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,267.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,870.51
|
| Rate for Payer: Quartz Commercial |
$4,739.40
|
| Rate for Payer: WEA Trust Commercial |
$4,344.45
|
| Rate for Payer: WPS Commercial |
$5,850.79
|
|
|
KIT LITHOCLAST TRILOGY PROBE 3.9MM X 440MM & STONE CATCHER M0068403550/M0068402980/M0068402940
|
Facility
|
OP
|
$7,899.00
|
|
| Hospital Charge Code |
5459256
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,211.72 |
| Max. Negotiated Rate |
$31,596.00 |
| Rate for Payer: Aetna Commercial |
$7,109.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,793.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,211.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,134.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,949.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,791.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,186.47
|
| Rate for Payer: Cash Price |
$2,369.70
|
| Rate for Payer: Cigna Commercial |
$7,267.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,420.28
|
| Rate for Payer: Health EOS Commercial |
$7,030.11
|
| Rate for Payer: HFN Commercial |
$7,267.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,924.25
|
| Rate for Payer: Multiplan Commercial |
$6,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,739.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,267.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,870.51
|
| Rate for Payer: Quartz Commercial |
$5,134.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,739.40
|
| Rate for Payer: The Alliance Commercial |
$31,596.00
|
| Rate for Payer: WEA Trust Commercial |
$4,344.45
|
| Rate for Payer: WPS Commercial |
$5,850.79
|
|
|
KIT MATERNITY LATEX FREE
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
2963265
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$153.86 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$188.40
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
KIT MATERNITY LATEX FREE
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
2963265
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.92 |
| Max. Negotiated Rate |
$1,256.00 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Aetna Managed Medicare |
$87.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.71
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$204.10
|
| Rate for Payer: Quartz Medicare Advantage |
$188.40
|
| Rate for Payer: The Alliance Commercial |
$1,256.00
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
KIT MICRO-PUNCTURE 4FR 15 CM
|
Facility
|
IP
|
$5,796.00
|
|
| Hospital Charge Code |
2973606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,840.04 |
| Max. Negotiated Rate |
$5,332.32 |
| Rate for Payer: Aetna Commercial |
$5,216.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,984.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.88
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,332.32
|
| Rate for Payer: Health EOS Commercial |
$5,158.44
|
| Rate for Payer: HFN Commercial |
$5,332.32
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,332.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,840.04
|
| Rate for Payer: Quartz Commercial |
$3,477.60
|
| Rate for Payer: WEA Trust Commercial |
$3,187.80
|
| Rate for Payer: WPS Commercial |
$4,293.10
|
|
|
KIT MICRO-PUNCTURE 4FR 15 CM
|
Facility
|
OP
|
$5,796.00
|
|
| Hospital Charge Code |
2973606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,622.88 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna Commercial |
$5,216.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,984.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,767.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,898.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,782.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.88
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,332.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,243.44
|
| Rate for Payer: Health EOS Commercial |
$5,158.44
|
| Rate for Payer: HFN Commercial |
$5,332.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,347.00
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,332.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,840.04
|
| Rate for Payer: Quartz Commercial |
$3,767.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,477.60
|
| Rate for Payer: The Alliance Commercial |
$23,184.00
|
| Rate for Payer: WEA Trust Commercial |
$3,187.80
|
| Rate for Payer: WPS Commercial |
$4,293.10
|
|
|
KIT MICROSMOOTH SLEEVE 8065750517
|
Facility
|
OP
|
$814.00
|
|
| Hospital Charge Code |
2964172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.04
|
| Rate for Payer: Aetna Managed Medicare |
$227.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$390.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.42
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$748.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.51
|
| Rate for Payer: Health EOS Commercial |
$724.46
|
| Rate for Payer: HFN Commercial |
$748.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$610.50
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: NAPHCARE Commercial |
$488.40
|
| Rate for Payer: Preferred Network Access Commercial |
$748.88
|
| Rate for Payer: Quartz Beloit One Network |
$398.86
|
| Rate for Payer: Quartz Commercial |
$529.10
|
| Rate for Payer: Quartz Medicare Advantage |
$488.40
|
| Rate for Payer: The Alliance Commercial |
$3,256.00
|
| Rate for Payer: WEA Trust Commercial |
$447.70
|
| Rate for Payer: WPS Commercial |
$602.93
|
|
|
KIT MICROSMOOTH SLEEVE 8065750517
|
Facility
|
IP
|
$814.00
|
|
| Hospital Charge Code |
2964172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.86 |
| Max. Negotiated Rate |
$748.88 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.42
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$748.88
|
| Rate for Payer: Health EOS Commercial |
$724.46
|
| Rate for Payer: HFN Commercial |
$748.88
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: NAPHCARE Commercial |
$488.40
|
| Rate for Payer: Preferred Network Access Commercial |
$748.88
|
| Rate for Payer: Quartz Beloit One Network |
$398.86
|
| Rate for Payer: Quartz Commercial |
$488.40
|
| Rate for Payer: WEA Trust Commercial |
$447.70
|
| Rate for Payer: WPS Commercial |
$602.93
|
|
|
KIT MONOPTY BIOPSY 16 GA
|
Facility
|
OP
|
$1,238.00
|
|
| Hospital Charge Code |
2962993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.64 |
| Max. Negotiated Rate |
$4,952.00 |
| Rate for Payer: Aetna Commercial |
$1,114.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| Rate for Payer: Aetna Managed Medicare |
$346.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$804.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$619.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$594.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$656.14
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,138.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.78
|
| Rate for Payer: Health EOS Commercial |
$1,101.82
|
| Rate for Payer: HFN Commercial |
$1,138.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$928.50
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: NAPHCARE Commercial |
$742.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.96
|
| Rate for Payer: Quartz Beloit One Network |
$606.62
|
| Rate for Payer: Quartz Commercial |
$804.70
|
| Rate for Payer: Quartz Medicare Advantage |
$742.80
|
| Rate for Payer: The Alliance Commercial |
$4,952.00
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| Rate for Payer: WPS Commercial |
$916.99
|
|
|
KIT MONOPTY BIOPSY 16 GA
|
Facility
|
IP
|
$1,238.00
|
|
| Hospital Charge Code |
2962993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.62 |
| Max. Negotiated Rate |
$1,138.96 |
| Rate for Payer: Aetna Commercial |
$1,114.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$656.14
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,138.96
|
| Rate for Payer: Health EOS Commercial |
$1,101.82
|
| Rate for Payer: HFN Commercial |
$1,138.96
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: NAPHCARE Commercial |
$742.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.96
|
| Rate for Payer: Quartz Beloit One Network |
$606.62
|
| Rate for Payer: Quartz Commercial |
$742.80
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| Rate for Payer: WPS Commercial |
$916.99
|
|
|
KIT NANONEEDLE HIGH FLOW CT 125MM AR-3210-0052
|
Facility
|
OP
|
$2,355.00
|
|
| Hospital Charge Code |
6234126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.40 |
| Max. Negotiated Rate |
$9,420.00 |
| Rate for Payer: Aetna Commercial |
$2,119.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,025.30
|
| Rate for Payer: Aetna Managed Medicare |
$659.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,530.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,130.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,248.15
|
| Rate for Payer: Cash Price |
$706.50
|
| Rate for Payer: Cigna Commercial |
$2,166.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,317.86
|
| Rate for Payer: Health EOS Commercial |
$2,095.95
|
| Rate for Payer: HFN Commercial |
$2,166.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,766.25
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,413.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,166.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.95
|
| Rate for Payer: Quartz Commercial |
$1,530.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,413.00
|
| Rate for Payer: The Alliance Commercial |
$9,420.00
|
| Rate for Payer: WEA Trust Commercial |
$1,295.25
|
| Rate for Payer: WPS Commercial |
$1,744.35
|
|
|
KIT NANONEEDLE HIGH FLOW CT 125MM AR-3210-0052
|
Facility
|
IP
|
$2,355.00
|
|
| Hospital Charge Code |
6234126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,153.95 |
| Max. Negotiated Rate |
$2,166.60 |
| Rate for Payer: Aetna Commercial |
$2,119.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,025.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,248.15
|
| Rate for Payer: Cash Price |
$706.50
|
| Rate for Payer: Cigna Commercial |
$2,166.60
|
| Rate for Payer: Health EOS Commercial |
$2,095.95
|
| Rate for Payer: HFN Commercial |
$2,166.60
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,413.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,166.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.95
|
| Rate for Payer: Quartz Commercial |
$1,413.00
|
| Rate for Payer: WEA Trust Commercial |
$1,295.25
|
| Rate for Payer: WPS Commercial |
$1,744.35
|
|
|
KIT NEBULIZER AERONEB SOLO ADULT 06-AG-AS3350-US
|
Facility
|
OP
|
$811.00
|
|
| Hospital Charge Code |
4594778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.08 |
| Max. Negotiated Rate |
$3,244.00 |
| Rate for Payer: Aetna Commercial |
$729.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.46
|
| Rate for Payer: Aetna Managed Medicare |
$227.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$527.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$405.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$389.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.83
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$746.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$453.84
|
| Rate for Payer: Health EOS Commercial |
$721.79
|
| Rate for Payer: HFN Commercial |
$746.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$608.25
|
| Rate for Payer: Multiplan Commercial |
$648.80
|
| Rate for Payer: NAPHCARE Commercial |
$486.60
|
| Rate for Payer: Preferred Network Access Commercial |
$746.12
|
| Rate for Payer: Quartz Beloit One Network |
$397.39
|
| Rate for Payer: Quartz Commercial |
$527.15
|
| Rate for Payer: Quartz Medicare Advantage |
$486.60
|
| Rate for Payer: The Alliance Commercial |
$3,244.00
|
| Rate for Payer: WEA Trust Commercial |
$446.05
|
| Rate for Payer: WPS Commercial |
$600.71
|
|
|
KIT NEBULIZER AERONEB SOLO ADULT 06-AG-AS3350-US
|
Facility
|
IP
|
$811.00
|
|
| Hospital Charge Code |
4594778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$397.39 |
| Max. Negotiated Rate |
$746.12 |
| Rate for Payer: Aetna Commercial |
$729.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.83
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$746.12
|
| Rate for Payer: Health EOS Commercial |
$721.79
|
| Rate for Payer: HFN Commercial |
$746.12
|
| Rate for Payer: Multiplan Commercial |
$648.80
|
| Rate for Payer: NAPHCARE Commercial |
$486.60
|
| Rate for Payer: Preferred Network Access Commercial |
$746.12
|
| Rate for Payer: Quartz Beloit One Network |
$397.39
|
| Rate for Payer: Quartz Commercial |
$486.60
|
| Rate for Payer: WEA Trust Commercial |
$446.05
|
| Rate for Payer: WPS Commercial |
$600.71
|
|
|
KIT NEPHROSTOMY 10.2FR X 25CM ULTRATHANE MAC-LOC AND SLIP-COAT G17156
|
Facility
|
OP
|
$2,637.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5384649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$738.36 |
| Max. Negotiated Rate |
$10,548.00 |
| Rate for Payer: Aetna Commercial |
$2,373.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,267.82
|
| Rate for Payer: Aetna Managed Medicare |
$738.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,714.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,318.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,265.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,397.61
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,426.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.67
|
| Rate for Payer: Health EOS Commercial |
$2,346.93
|
| Rate for Payer: HFN Commercial |
$2,426.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,977.75
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,582.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,426.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.13
|
| Rate for Payer: Quartz Commercial |
$1,714.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.20
|
| Rate for Payer: The Alliance Commercial |
$10,548.00
|
| Rate for Payer: WEA Trust Commercial |
$1,450.35
|
| Rate for Payer: WPS Commercial |
$1,953.23
|
|
